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1、NPLEX Combination Review Immunology / Toxicology,Paul S. Anderson, ND Medical Board Review Services Copyright MBRS,Laboratory Testing Methodologies,PCR: Polymerase Chain Reaction ELISA(Enzyme Linked Immunosorbant Assay) Measures IgG / M / AUsed in disease detection and Allergen identification. RAST
2、Quantifies IgE antibodies. Intradermal testing Positive reaction demonstrates erythema at point of injection. Blood immunoglobins IgG Delayed hypersensitivity reaction to antigen. IgE Immediate hypersensitivity reaction to antigen. Electrodermal allergy test EAV is appropriate example.,ID Immunology
3、: General,Cultures Take time Some things grow, some dont Antibody Testing Good for effect Some better than others DNA (PCR) Testing Detects DNA of the subject of the probe No need for growing a culture No need for Ig interpretation Can get Quantitative (viral load) tests,Antibody Testing,Serum tests
4、. Serum must be separated from clot / SST Gel within 1 hour! Pipette serum into a plastic transport tube Excessive exposure to the gel in the SST will bind antibodies, causing false negative tests. Used for allergy testing, Autoimmune testing, Exposure Ig (Immunoglobulin) Types: IgG: Long term expos
5、ure, Delayed reactions (ie. Food allergy). IgG lasts a long time, and is a marker of EXPOSURE, not successful treatment. IgM: Acute phase reactions. Indicates recent infection or re-exposure. IgA: Secretory Ig. Shows mucosal response, and is a good marker of successful treatment. Can be measured in
6、the serum, stool and saliva IgE: Anaphylaxis. (Type-1 Reaction). Total IgE in serum is a test for general allergic level in the patient Traditionally the marker used for food and Inhalant allergy, although IgG is more helpful with most food reactions.,Antibody Testing - 2,High IgG, Low IgM or IgA Pr
7、obable past infection / exposure. Inactive or cured. In food allergy testing IgG is always considered active, but delayed response allergy. Low IgG, High IgM New infection / Exposure High IgG, High IgM Reactivated infection / Exposure High IgG, Low IgM, High IgA Current immune response (mucosal) tha
8、t is past the initial IgM response window. (On going problem).,Autoimmune Disorders,Anti-nuclear antibody (ANA) Titer level is important: 1:160 “positive” Screening test for connective-tissue diseases: RA, SLE, Lupus, MCTD, CREST Syndrome, Scleroderma, and Polymyositis. Use confirmatory ANA sub-test
9、ing to confirm specific disease Dx. Often ordered as ANA + Reflex (7 or 9 values) run if ANAA is positive Erythrocyte Sedimentation Rate (ESR) Nonspecific measure of inflammation Diagnostic in very few conditions (Giant cell arteritis) Can also indicate cancerous effect C-reactive protein (CRP) Scre
10、ening for nondescriptive inflammatory and infection disease processes. Also used for discriminating among DDX and monitoring disease process CRP elevation: RA, Reiters, vasculitis, rheumatic fever, neonatal and post-operative infections, pyelonephritis, MI and embolism.,Autoimmune Disorders,Rheumato
11、id factor (RF) Used in the diagnosis and evaluation of RA and other CTD; Highest in RA, but also elevated in CVD, MI, renal disease, malignancy, thyroid and liver disease, SLE, scleroderma and polyarteritis nodosa. Parvo B-19 viral assay Consider in RF Negative woman nursing or caring for a young ch
12、ild who presents with RA like symptoms. Human leukocyte antigen (HLA) HLA B-27 most common. Glycoproteins that may be serologically determined; usually performed for transplantation matches but also elevated in AS, Reiters Syndrome, MS, chronic active hepatitis, gluten-sensitive enteropathy, SLE, DM
13、 and hemochromatosis. Consider Chlamydia testing (Reiters),Autoimmune Disorders,Anti-thyroid antibody (Anti Microsomal or TPO Ab) Used in diagnosis and classification of inflammatory and autoimmune thyroid disease. Marker for Hashimotos thyroiditis, atrophic thyroiditis, and Graves Disease. Antithyr
14、oglobulin Antibody (Anti TG) Detect and confirm autoimmune thyroiditis, Hashimoto thyroiditis Thyroid-Stimulating Immunoglobulin (Thytrophin Receptor Ab) Detect Graves Dz. Order when Graves Sn/Sx and TPO elevation,THYROID HORMONE SYNTHESIS,Infectious Disease Testing,Anti-Streptolysin-O test (ASO) (2
15、00iu/ml) Elevation in titers reflect immunologic response to streptococcus; ASO titers clinically useful if serum is obtained in 2-3 week intervals. Chlamydia antibody (IgG, IgM) Presence of IgG Ab indicates chlamydial infection in the past; highly sensitive but has low specificity. Presence of IgM
16、or 4-fold increase from acute convalescence = recent infection. Cytomegalovirus PCR Cytomegalovirus (CMV- IgG, IgM) Presence of IgM or 4-fold increase in IgG = recent infection,Infectious Disease Testing,Epstein-Barr Virus (EBV) Monospot: Screening test performed with symptomatic Pt. (false negative in adults 10%). Measures IgM heterophil antibodies. Positive window: 4-21 days PCR for EBV: Most sensitive test is Quantitative (viral load) PCR Used in Chronic reactivating case
